Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision

Abstract

Prenatal diagnosis of choledochal cysts results in earlier definitive surgery. More adverse complications were seen in those who had surgery at an older age. We therefore recommend early excision of choledochal cysts.

Choledochal cysts in infants and children: experiences over a 20-year period at a single institution

“…Prolonged jaundice with acholic stools and a small cyst size (<8 mm in diameter) in subjects in this age group suggest the possibility of a biliary atresia-associated choledochal cyst [8,12,14,25]. Central to an understanding of the difference between biliary atresia with cystic dilatation and choledochal cysts in neonates/infants is the concept that biliary atresia is a panductal disease with sclerosis and inflammation extending into the intrahepatic bile ducts [27].…”

“…Endoscopic retrograde cholangiopancreatography under general anesthesia [16] and magnetic resonance cholangiopancreatography (MRCP) [22] are recommended diagnostic approaches for choledochal cysts in children although prenatal ultrasonography results in earlier definitive surgery with lesser complications [8]. Laparoscopic Roux-en-Y hepaticojejunostomy is reported to be safe for both infants and children [8,12,14,15].…”

Biliary-enteric reconstruction with hepaticoduodenostomy following laparoscopic excision of choledochal cyst is associated with better postoperative outcomes: a single-centre experience

“…Diao et al [18] advocated early surgical intervention in the neonatal period since prenatally diagnosed choledochal cysts were found to have a tendency of developing liver fibrosis earlier in life and earlier operations were associated with less complications. Foo et al [19] reviewed our past experience and found that prenatal diagnosis of choledochal cysts resulted in earlier definitive surgery which associated with fewer adverse complications. The best time for operation for those with prenatal diagnosis was a balance between anaesthetic risk, body size for laparoscopic surgery and risk of cyst complications leading to infection, adhesion and more difficult operation afterwards.…”

Two-Dimensional Ultrasonographic Prenatal Diagnosis of Choledochal Cyst: Our Experience and Literature Review

“…In the present paper, a type I CC was diagnosed at 22-week prenatal US as based on the findings of an abdominal mass, negative to ColorDoppler, completely separated from the other intra-abdominal organs and in continuation with the gallbladder and the dilated choledochal duct.The latter observation (of a communication between the various structures) is original in that it never has been described previously in literature to our knowledge; previous reports of prenatal US diagnoses mentioneda simple, cystic mass in the upper abdomen or right upper quadrant,separated by the others intra-abdominal organs [3][4][5][6][7]. The US visualization of this communication between structures may be a simple, but valuable sign for addressing the correct diagnosis.…”

“…Prenatal detection of CC is crucial since the newborn can be scheduled to a pre-emptive surgical treatment, and avoiding the occurrence of complications [3]. Nevertheless, diagnosis of CC at prenatal ultrasound is still challenging.…”